Intensive insulin therapy requires frequent blood glucose self-monitoring. What are some of the barriers to success for patients who begin this type of therapy? Give suggestions on how you might work with Matias to support his compliance

Question

What will be an ideal response?

Answer 1

• Intensive insulin therapy is a flexible insulin regimen compared to conventional or standard therapy. Conventional is a fixed insulin dose whereas intensive insulin therapy uses SBGM to determine how much insulin to give at meal times plus it uses a basal insulin dose based on the patient's weight.
• Intensive insulin therapy requires multiple daily injections of bolus insulin before meals in addition to basal insulin once or twice daily.
• Intensive insulin therapy, when compared to standard therapy, has demonstrated better glycemic control but it requires patients to self-monitor their blood glucose levels.
• Barriers to success:
Compliance with giving multiple daily injections
Compliance with checking blood glucose levels in the morning, preprandially and post-prandially
Learning to carbohydrate count
Inconvenience of carrying glucometer with normal daily living activities
Learning how to accurately use glucometer and how to calculate insulin dosages needed
Lack of support system
Fear of hypoglycemia

• Health practitioners can help the patient overcome barriers by providing education and support
Educate patient on how to effectively use glucometer. Have patient practice on himself and the dietitian to make sure he understands the proper technique to monitor blood glucose.
Educate patient on carb counting. Have patient develop sample meals to demonstrate that patient understands the process of carb counting. Providing the patient with the Exchange List booklet can be beneficial.
Have patient practice injections.
Give patient recording tools such as graphs and charts that may help the patient keep track of physical activity, blood glucose levels, and carbohydrate intake.
Teach patient about signs/symptoms of hypoglycemia and the appropriate treatment.
Help patient develop appropriate target blood glucose ranges using the ADA guidelines.
Refer to SBGM as "monitoring" and avoid saying the word "testing."